New rules define unsafe drivers

Remove age, illness as factors

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More than two years after a string of high-profile accidents by older drivers, Massachusetts health regulators voted unanimously Wednesday to approve new rules that, for the first time, define what it means to be too physically or cognitively impaired to drive safely. The rules make clear that age and illness are not by themselves disqualifying.

Instead, the decision will be based on ‘‘observations or evidence of the actual effect’’ that an impairment may have on a person’s ability to safely drive, according to the rules, developed after months of public hearings and advice from medical specialists.

The state Public Health Council, an appointed panel of physicians, consumer advocates, and professors, adopted the rules with little discussion.

The rules define cognitive impairment as an impediment that ‘‘limits a person’s ability to sustain attention, avoid distraction, understand the immediate driving context, and refrain from impulsive responding.’’

Age-related concerns became a flashpoint in 2010, when a spate of highly publicized accidents prompted state legislators to consider a mandatory driving test for older drivers, a proposal that drew the ire of several advocacy groups.

The law that was eventually adopted in 2010 stopped short of mandatory tests, but does prohibit those over 75 from renewing their licenses online. Lawmakers hoped the requirement to visit a Registry branch and take a vision test would make the least fit senior drivers think twice before renewing.

The 2010 law also required the state Department of Public Health to define cognitive and functional impairments to guide health care providers in judging their patients’ ability to drive safely.

The law included a provision to encourage health care providers and police officers to feel more comfortable filing confidential reports to the state Registry of Motor Vehicles by protecting them from lawsuits when filing a report about a suspected impaired driver.

Elizabeth Dugan, an associate professor who specializes in aging issues at the University of Massachusetts Boston, said the proposed rules are ‘‘evidence-based and clinically relevant guidelines that should be helpful.’’

Dugan, who testified during legislative hearings on the issue, has long argued against arbitrary age-based driving tests.

‘‘We need to focus on what we know is related to safe driving and not ageist stereotype,’’ she said.

Gerald Flaherty, vice president of medical and scientific programs at the Alzheimer’s Association of Massachusetts and New Hampshire, said the proposed rules strike an appropriate balance between individual rights and the need to protect public safety.

But Flaherty said the issue is likely to get muddy when implemented because many primary care physicians may have trouble distinguishing the signs of dementia.

‘‘If clinicians are not recognizing dementia in the first place, it’s going to be difficult for them to recognize one’s driving ability that may be affected,’’ Flaherty said. ‘‘But you also want to be fair in how you apply these regulations because many people in the early stages of dementia can drive safely.’’

The regulations also detail what constitutes functional impairments. The list includes an ‘‘inability or diminished capacity to consistently maintain a firm grasp on or manipulate a steering wheel or driving hand controls.’’

It also stipulates that ‘‘weakness or paralysis of muscles affecting ability to consistently maintain sitting balance’’ be considered an impairment.

Steven Evans, director of medical affairs at the registry, said that in the first three months of 2012, the agency has revoked about 1,000 licenses for medical reasons, which include impairments, such as for seizures or heart conditions, that are already included in agency rules.

Evans said the agency compiled about 3,500 revocations in 2011 related to physical or medical problems.

Kay Lazar can be reached at klazar@globe.com. Follow her on Twitter @GlobeKayLazar.